Highlights & Basics
- Foreign body aspiration is characterized by inhalation of a foreign body into the larynx and respiratory tract.
- Acute symptoms include sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main or distal bronchi. Longer-term symptoms can include development of atelectasis, nodules, abscesses, and cavities.
- Major causes of foreign body aspiration are altered mental status from alcohol or sedative use, seizure, neurologic disorders, trauma associated with a decreased level of consciousness, dental procedures, advanced or young age, and disorders associated with dysphagia and impaired cough reflex.
- Flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body. Rigid bronchoscopy is performed if flexible bronchoscopy fails.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Citations
Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J. 2009 Feb;102(2):171-4.[Abstract]
Faro A, Wood RE, Schechter MS, et al. Official American Thoracic Society technical standards: flexible airway endoscopy in children. Am J Respir Crit Care Med. 2015 May 1;191(9):1066-80.[Abstract][Full Text]
Hewlett JC, Rickman OB, Lentz RJ, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-409.[Abstract][Full Text]
Perkins GD, Graesner JT, Semeraro F, et al. European Resuscitation Council Guidelines 2021: executive summary. Resuscitation. 2021 Apr;161:1-60.[Abstract]
1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71.[Abstract]
2. Fang YF, Hsieh MH, Chung FT, et al. Flexible bronchoscopy with multiple modalities for foreign body removal in adults. PLoS One. 2015 Mar 13;10(3):e0118993.[Abstract][Full Text]
3. Karakoc F, Cakir E, Ersu R, et al. Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms. Int J Pediatr Otorhinolaryngol. 2007 Feb;71(2):241-6.[Abstract]
4. Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J. 2009 Feb;102(2):171-4.[Abstract]
5. Swanson KL, Prakash UB, Midthun DE, et al. Flexible bronchoscopic management of airway foreign bodies in children. Chest. 2002 May;121(5):1695-700.[Abstract]
6. Wu Y, Zhang X, Lin Z, et al. Changes in the global burden of foreign body aspiration among under-5 children from 1990 to 2019. Front Pediatr. 2023;11:1235308.[Abstract][Full Text]
7. Hammond CAS, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 suppl):S154-68.[Abstract][Full Text]
8. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990 Apr 15;112(8):604-9.[Abstract]
9. Wick R, Gilbert JD, Byard RW. Café coronary syndrome-fatal choking on food: an autopsy approach. J Clin Forensic Med. 2006 Apr;13(3):135-8.[Abstract]
10. Centers for Disease Control and Prevention WISQARS™. 10 Leading causes of death, United States 2021. 2021 [internet publication].[Full Text]
11. Cramer JD, Meraj T, Lavin JM, et al. Object-related aspiration deaths in children and adolescents in the United States, 1968 to 2017. JAMA. 2019 Nov 26;322(20):2020-22.[Abstract][Full Text]
12. Susini G, Pommel L, Camps J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. Int Endod J. 2007 Aug;40(8):585-9.[Abstract]
13. Foltran F, Ballali S, Rodriguez H, et al. Inhaled foreign bodies in children: a global perspective on their epidemiological, clinical, and preventive aspects. Pediatr Pulmonol. 2013 Apr;48(4):344-51. [Abstract]
14. Righini CA, Morel N, Karkas A, et al. What is the diagnostic value of flexible bronchoscopy in the initial investigation of children with suspected foreign body aspiration? Int J Pediatr Otorhinolaryngol. 2007 Sep;71(9):1383-90.[Abstract]
15. Kim IA, Shapiro N, Bhattacharyya N. The national cost burden of bronchial foreign body aspiration in children. Laryngoscope. 2015 May;125(5):1221-4.[Abstract]
16. Mansour B, Elias N. Foreign body aspiration in children with focus on the role of flexible bronchoscopy: a 5 year experience. Isr Med Assoc J. 2015 Oct;17(10):599-603.[Abstract]
17. Obinata K, Satoh T, Towfik AM, et al. An investigation of accidental ingestion during dental procedures. J Oral Sci. 2011 Dec;53(4):495-500.[Abstract][Full Text]
18. National Health Service England. National Patient Safety Alert - foreign body aspiration during intubation, advanced airway management or ventilation. Aug 2020 [internet publication].[Full Text]
19. Nasir ZM, Subha ST. A five-year review on pediatric foreign body aspiration. Int Arch Otorhinolaryngol. 2021 Apr;25(2):e193-e9.[Abstract]
20. Hadjikoutis S, Wiles CM. Respiratory complications related to bulbar dysfunction in motor neuron disease. Acta Neurol Scand. 2001 Apr;103(4):207-13.[Abstract]
21. Gan W, Xiao N, Feng Y, et al. Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors. BMC Surg. 2021 Mar 3;21(1):108.[Abstract][Full Text]
22. Chand R, Shaikh M, Khan Y, et al. Frequency of various foreign bodies retrieved from the airway during bronchoscopy in children: a pediatric tertiary care center experience. Cureus. 2020 Jul 22;12(7):e9348.[Abstract]
23. Jang G, Song JW, Kim HJ, et al. Foreign-body aspiration into the lower airways in adults; multicenter study. PLoS One. 2022;17(7):e0269493.[Abstract][Full Text]
24. Lundy DS, Smith C, Colangelo L, et al. Aspiration: cause and implications. Otolaryngol Head Neck Surg. 1999 Apr;120(4):474-8.[Abstract]
25. Lluna J, Olabarri M, Domènech A, et al. [Recommendations for the prevention of foreign body aspiration]. [in spa]. An Pediatr (Barc). 2017 Jan;86(1):50.e1-50.e6.[Abstract]
26. The Royal Children's Hospital Melbourne. Foreign bodies inhaled. Mar 2021 [internet publication].[Full Text]
27. Committee on Injury, Violence, and Poison Prevention; American Academy of Pediatrics. Prevention of choking among children. Pediatrics. 2010 Mar;125(3):601-7.[Abstract][Full Text]
28. Göktas O, Snidero S, Jahnke V, et al. Foreign body aspiration in children: field report of a German hospital. Pediatr Int. 2010 Feb;52(1):100-3.[Abstract]
29. Australian Journal of General Practice. Paediatric inhaled airway foreign bodies: an update. Apr 2019 [internal publication].[Full Text]
30. Verghese ST, Hannallah RS. Pediatric otolaryngologic emergencies. Anesthesiol Clin North Am. 2001 Jun;19(2):237-56, vi.[Abstract]
31. Lee JJW, Philteos J, Levin M, et al. Clinical prediction models for suspected pediatric foreign body aspiration: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021 Sep 1;147(9):787-96.[Abstract][Full Text]
32. Greif R, Bray JE, Djärv T, et al. 2024 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation. 2024 Dec 10;150(24):e580-687.[Abstract][Full Text]
33. Shlizerman L, Mazzawi S, Rakover Y, et al. Foreign body aspiration in children: the effects of delayed diagnosis. Am J Otolaryngol. 2010 Sep-Oct;31(5):320-4.[Abstract]
34. Chang AB, Oppenheimer JJ, Irwin RS, et al. Managing chronic cough as a symptom in children and management algorithms: CHEST guideline and expert panel report. Chest. 2020 Jul;158(1):303-29.[Abstract][Full Text]
35. Paintal HS, Kuschner WG. Aspiration syndromes: 10 clinical pearls every physician should know. Int J Clin Pract. 2007 May;61(5):846-52.[Abstract]
36. Ell SR, Sprigg A. The radio-opacity of fishbones - species variation. Clin Radiol. 1991 Aug;44(2):104-7.[Abstract]
37. Pinto A, Scaglione M, Pinto F. Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography. Radiol Med. 2006 Jun;111(4):497-506.[Abstract]
38. Kavanagh PV, Mason AC, Müller NL. Thoracic foreign bodies in adults. Clin Radiol. 1999 Jun;54(6):353-60.[Abstract]
39. Bai W, Zhou X, Gao X, et al. Value of chest CT in the diagnosis and management of tracheobronchial foreign bodies. Pediatr Int. 2011 Aug;53(4):515-8.[Abstract]
40. Friedman EM, Anthony B. A five-year analysis of airway foreign body management: toward a better understanding of negative bronchoscopies. Ann Otol Rhinol Laryngol. 2016 Jul;125(7):591-5.[Abstract]
41. Jung SY, Pae SY, Chung SM, et al. Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients. Eur Arch Otorhinolaryngol. 2012 Jan;269(1):223-8.[Abstract]
42. Bhat KV, Hegde JS, Nagalotimath US, et al. Evaluation of computed tomography virtual bronchoscopy in paediatric tracheobronchial foreign body aspiration. J Laryngol Otol. 2010 Aug;124(8):875-9. [Abstract]
43. Eber E, Antón-Pacheco JL, de Blic J, et al. ERS statement: interventional bronchoscopy in children. Eur Respir J. 2017 Dec;50(6):1700901.[Abstract]
44. Chantzaras AP, Panagiotou P, Karageorgos S, et al. A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients. Acta Paediatr. 2022 Jul;111(7):1301-12.[Abstract]
45. Martinot A, Closset M, Marquette CH, et al. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration. Am J Respir Crit Care Med. 1997 May;155(5):1676-9.[Abstract]
46. Tang LF, Xu YC, Wang YS, et al. Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000-2008. World J Pediatr. 2009 Aug;5(3):191-5.[Abstract]
47. Golan-Tripto I, Mezan DW, Tsaregorodtsev S, et al. From rigid to flexible bronchoscopy: a tertiary center experience in removal of inhaled foreign bodies in children. Eur J Pediatr. 2021 May;180(5):1443-50.[Abstract]
48. Cakir E, Ersu RH, Uyan ZS, et al. Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children. Int J Pediatr Otorhinolaryngol. 2009 Dec;73(12):1666-8.[Abstract]
49. Farrell P. Rigid bronchoscopy for foreign body removal: anaesthesia and ventilation. Pediatr Anaesth. 2004 Jan;14(1):84-9.[Abstract]
50. Faro A, Wood RE, Schechter MS, et al. Official American Thoracic Society technical standards: flexible airway endoscopy in children. Am J Respir Crit Care Med. 2015 May 1;191(9):1066-80.[Abstract][Full Text]
51. Ma W, Hu J, Yang M, et al. Application of flexible fiberoptic bronchoscopy in the removal of adult airway foreign bodies. BMC Surg. 2020 Jul 23;20(1):165.[Abstract][Full Text]
52. Sehgal IS, Dhooria S, Ram B, et al. Foreign body inhalation in the adult population: experience of 25,998 bronchoscopies and systematic review of the literature. Respir Care. 2015 Oct;60(10):1438-48.[Abstract][Full Text]
53. Du Rand IA, Barber PV, Goldring J, et al. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax. 2011 Nov;66(suppl 3):iii1-21.[Abstract]
54. Baharloo F, Veyckemans F, Francis C, et al. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest. 1999 May;115(5):1357-62.[Abstract]
55. Lan RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J. 1994 Mar;7(3):510-4.[Abstract][Full Text]
56. Aydin O, Birbilen AZ, User IR, et al. Lung ultrasound findings in children with foreign body aspiration. J Clin Ultrasound. 2023 Mar;51(3):447-51.[Abstract]
57. Hewlett JC, Rickman OB, Lentz RJ, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-409.[Abstract][Full Text]
58. Bajaj D, Sachdeva A, Deepak D. Foreign body aspiration. J Thorac Dis. 2021 Aug;13(8):5159-75.[Abstract][Full Text]
59. Perkins GD, Graesner JT, Semeraro F, et al. European Resuscitation Council Guidelines 2021: executive summary. Resuscitation. 2021 Apr;161:1-60.[Abstract]
60. Couper K, Abu Hassan A, Ohri V, et al. Removal of foreign body airway obstruction: a systematic review of interventions. Resuscitation. 2020 Nov;156:174-81.[Abstract][Full Text]
61. Basile A, Spagnuolo R, Cosco V, et al. Esophageal rupture after Heimlich maneuver: a case report and literature review. Minerva Gastroenterol (Torino). 2023 Dec;69(4):566-70.[Abstract]
62. Cecchetto G, Viel G, Cecchetto A, et al. Fatal splenic rupture following Heimlich maneuver: case report and literature review. Am J Forensic Med Pathol. 2011 Jun;32(2):169-71.[Abstract]
63. De Lesquen H, Cardinale M, Bergez M, et al. Foreign body removal by a lung-sparing bronchotomy. Multimed Man Cardiothorac Surg. 2022 Aug 22;2022.[Abstract][Full Text]
64. Lim SY, Sohn SB, Lee JM, et al. Severe endobronchial inflammation induced by aspiration of a ferrous sulfate tablet. Tuberc Respir Dis (Seoul). 2016 Jan;79(1):37-41.[Abstract][Full Text]
65. Lee P, Culver DA, Farver C, et al. Syndrome of iron pill aspiration. Chest. 2002 Apr;121(4):1355-7.[Abstract]
66. Shimpi T, Chawla A, Shikhare S. Tell tale of tablets in bronchus. Med J Malaysia. 2015 Feb;70(1):36-7.[Abstract][Full Text]
67. Wurzel DF, Masters IB, Choo KL, et al. A case for early bronchoscopic airway assessment after disc battery ingestion. Pediatr Pulmonol. 2014;49:E72-E74.[Abstract]
68. Woo SH, Park JJ, Kwon M, et al. Tracheobronchial foreign body removal in infants who had very small airways: a prospective clinical trial. Clin Respir J. 2016 Nov 23;12(2):738-45.[Abstract]
69. Frykholm P, Disma N, Andersson H, et al. Pre-operative fasting in children: a guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2022 Jan 1;39(1):4-25.[Abstract][Full Text]
70. Litman RS. Anesthesia for tracheal or bronchial foreign body removal in children: an analysis of ninety-four cases. Anesth Analg. 2000 Dec;91(6):1389-91,[Abstract][Full Text]
71. Blanco Ramos M, Botana-Rial M, García-Fontán E, et al. Update in the extraction of airway foreign bodies in adults. J Thorac Dis. 2016 Nov;8(11):3452-3456.[Abstract][Full Text]
72. Swanson KL. Airway foreign bodies: what's new? Semin Respir Crit Care Med. 2004 Aug;25(4):405-11.[Abstract]
73. Patterson E, Tang HT, Ji C, et al. The efficacy and usability of suction-based airway clearance devices for foreign body airway obstruction: a manikin randomised crossover trial. Resusc Plus. 2021 Mar;5:100067.[Abstract][Full Text]
74. Parri N, Madera A, D'Aiuto F, et al. Systematic review shows that suction-based airway clearance devices for foreign body airway obstruction are promising. Acta Paediatr. 2024 Jul;113(7):1701-2.[Abstract]
75. International Liaison Committee on Resuscitation. Removal of foreign body airway obstruction (BLS 368): systematic review. Apr 2021 [internet publication].[Full Text]
76. Resuscitation Council UK. RCUK's position on the use of suction-based airway clearance devices on choking individuals. May 2024 [internet publication].[Full Text]
77. Wong SC, Tariq SM. Cardiac arrest following foreign-body aspiration. Respir Care. 2011 Apr;56(4):527-9.[Abstract][Full Text]
78. al-Majed SA, Ashour M, al-Mobeireek AF, et al. Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery. Respir Med. 1997 May;91(5):293-6.[Abstract]
79. National Center for Injury Prevention and Control. WISQARS leading causes of death reports, 1999-2015. Jun 2015 [internet publication].[Full Text]
80. Martin A, van der Meer G, Blair D, et al. Long-standing inhaled foreign bodies in children: characteristics and outcome. Int J Pediatr Otorhinolaryngol. 2016 Nov;90:49-53.[Abstract]
81. Shu L, Hu Y, Wei R, et al. Argon plasma coagulation combined with a flexible electronic bronchoscope for treating foreign body granulation tissues in children's deep bronchi: nine case reports. J Laparoendosc Adv Surg Tech A. 2016 Dec;26(12):1039-1040.[Abstract]
82. Pagán Rivera BL, Anselmi FJ, Torres Mdel M, et al. Usefulness of glucocorticoids in the management of foreign body aspiration. Bol Asoc Med P R. 2015 Jul-Sep;107(3):24-7.[Abstract]
83. The Children's Hospital of Philadelphia. Foreign body aspiration. 2024 [internet publication].[Full Text]
84. Karakoç F, Karadağ B, Akbenlioğlu C, et al. Foreign body aspiration: what is the outcome? Pediatr Pulmonol. 2002 Jul;34(1):30-6.[Abstract]
